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The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment
A A Boerlage1, E Ista, H J Duivenvoorden
1Intensive Care and Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, The Netherlands.
Insights
The COMFORT-B scale effectively detects changes in pain and distress in children after interventions. This validated tool can guide treatment decisions in pediatric intensive care.
Area of Science:
- Pediatric Intensive Care Medicine
- Pain and Distress Assessment
- Clinical Measurement Validation
Background:
- The COMFORT Behaviour Scale (COMFORT-B) is utilized in pediatric intensive care units (PICUs) to evaluate pain and distress in young children.
- Its application extends to assessing treatment intervention impacts, yet its sensitivity to change remains under-explored.
Purpose of the Study:
- To investigate the sensitivity to change of the COMFORT-B scale in pediatric patients.
- To determine if the COMFORT-B scale can reliably detect changes in pain and distress following interventions.
Main Methods:
- Retrospective analysis of 747 paired COMFORT-B scores collected during standard care.
- Scores were obtained before and after pharmacological interventions in 180 PICU patients.
- Data collected between September 2009 and September 2010.
Main Results:
- Mean COMFORT-B scores decreased significantly from 20.0 (SD 3.7) before intervention to 14.1 (SD 4.7) after intervention (p < 0.0001).
- A 6-point mean decline was observed post-intervention, indicating responsiveness.
- In 74% of cases, scores dropped below 17, signifying effective change detection.
Conclusions:
- This study provides the first evidence that the COMFORT-B scale is sensitive to treatment-related changes in pain or distress.
- The findings support the use of COMFORT-B assessments for guiding analgesic and sedation therapies in critically ill children.
Background:
The COMFORT behaviour scale (COMFORT-B scale) is widely used in paediatric intensive care units to assess young children's pain and distress. It is also used to assess the impact of treatment interventions, but little is known on the scale's sensitivity to detect changes between before and after measurements following an intervention. This study explored the sensitivity to change of the COMFORT-B scale.
Methods:
COMFORT-B scores, originally and prospectively collected as part of standard care, were retrieved from the digital patient data management system. We analysed scores obtained in 747 paired observations, i.e., before and after a pharmacological intervention in 180 paediatric intensive care patients between September 2009 and September 2010.
Results:
The mean scores before and after an intervention were 20.0 [standard deviation (SD) 3.7] and 14.1 (SD 4.7), respectively. Multilevel regression analysis showed a 6-point mean decline after an intervention (p < 0.0001). The magnitude of this decline was not statistically significantly related to number and type of interventions or time between assessments. In almost three-quarters of cases (74%), the COMFORT-B score dropped to below 17 after a pharmacological intervention, indicating good responsiveness.
Conclusions:
This is the first study demonstrating that the COMFORT-B scale detects treatment-related changes in pain or distress intensity. This implies that COMFORT-B assessments can effectively guide analgesic and sedation treatment in critically ill children.
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